Health assessment Exam 1

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Health assessment Exam 1
2010-09-28 16:15:25
Health assessment

244 exam 1
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  1. what is Subjective data gathered during the health assessment?
    What client tells you
  2. What is objective data gathered during health assessment?
    Information gathered during physical exam
  3. What are the purposes of a health history?
    understand client, promote health and wellness, council about disease prevention, negotiate plan of care
  4. What are 4 types of health history
    Initial, interval/follow up, focused/problem oriented, emergency
  5. What is involved in a history of present illness?
    Onset, Precipitating factors and progression, Quality and quantity, Relieving and aggravating factors, Sequelae, Timing, Understanding
  6. What are constitutional symptoms?
    Unexplained fever, night sweats, weight loss or gain, change in appetite, fatigue
  7. What are the ages for: childhood, adolescence, adulthood
    • Childhood - to 12
    • Adolescence - 12-18
    • Adulthood - 18+
  8. What is a question that must be asked with every health assessment?
    Any drug allergies
  9. How do you find a tobacco use pack history?
    packs/day x years smoking
  10. When taking a family history how far back do you go?
    If possible 3 generations - find out conditions, cause of death, current health
  11. What are the techniques of physical assessment?
    Observation/inspection, palpation, percussion, ascultation
  12. What are the plexor and pleximeter?
    • Plexor - middle finger that strikes during percussion
    • Pleximeter - stationary finger that is struck
  13. What pitches are the diaphragm and bell of the stethoscope used for?
    • Diaphragm - high pitched - breath and bowel, heart sounds
    • Bell - Bruits and cardiac murmurs
  14. What are the layers of the skin?
    • Epidermis - superficial, avascular, melanocytes
    • Dermis - vascular CT with sebacious glands and some hair follicles
    • Subcutanious tissue - fatty cells, sweat glands
  15. What is an apocrine gland?
    a gland that opens into a hair follicle, produces an odorless secretion in response to emotional stimuli, causes body odor due to bacterial decomposition
  16. What are three types of skin cancer?
    basal cell, squamous cell, malignant
  17. What are ABCDE of skin cancer
    Asymmetry, border, color, diameter, evolution
  18. What is carotine?
    golden yellow skin pigment, exists in subcutanious fat and keratinized areas. Carotenemia is excessive carotene causing yellowness that does NOT involve conjunctivae or other mucous membranes
  19. What is jaundice?
    increased bilirubin levels causing yellowness in skin, conjunctivae, etc. Suggests liver disease or excessive hemolysis of RBC. Check under NATURAL light.
  20. What is rubor?
    increase in blood flow causing reddening.
  21. What is pallor?
    decrease in blood flow making patient pale.
  22. What is cyanosis?
    increased concentration of deoxyhemoglobin due to hypoxia causing blueness of skin.
  23. What do you check for peripheral and central cyanosis?
    • Perepheral - nails, skin on extremeties
    • Central - BUCCAL MUCOSA, lips, tongue
  24. What is diapheresis?
    Excessive sweating
  25. Where and how do you check for turgor?
    check for tenting in sternoclavicular junction
  26. What are striae?
    stretch marks - silver or pink. Purple indicates possible Cushings
  27. What is Vitiligo?
    pigmentary disorder with loss of melanocytes. Chalk white, nonscaling, macular patches
  28. What is a primary skin lesion?
    A lesion that was not there before
  29. What is a macule?
    a flat, nonpalpable, circumscribed lesion under 1 cm eg. freckle, measle
  30. What is a patch?
    a flat, nonpalpable, circumscribed lesion over 1 cm e.g. vitiligo, stage 1 pressure ulcer
  31. What is a papule?
    an elevated, circumscribed, palpable, solid lesion under .5cm eg nevus, wart
  32. What is a plaque?
    elevated, circumscribed, palpable, solid over .5cm lesion. eg psoriasis
  33. What is a nodule?
    elevated, circumscribed, palpable, solid, .5cm - 2cm lesion, deeper and firmer than papule e.g. lipoma, cyst
  34. What is a tumor?
    elevated, circumscribed, palpable, solid over 2cm lesion e.g. carcinoma
  35. What is a wheal?
    a transient, irregular edematous variable sized lesion e.g insect bite/hive
  36. What is a vesicle?
    elevated, circumscribed, palpable, serious fluid filled lesion under 0.5cm e.g. herpes simplex, herpes zoster, chickenpox
  37. What is a bulla?
    elevated, circumscribed, palpable, serious fluid filled lesion over 0.5cm e.g. impetigo, large burn
  38. What is a pustule?
    vesicle or bulla that becomes pus filled e.g acne, impetigo, furuncles, carbuncles, folliculitus
  39. What is a cyst?
    encapsulated, fluid filled or semi-solid lesion in subcutanious tissue or dermis
  40. What is a secondary skin lesion?
    A lesion that results from a primary lesion
  41. What are above and below skin surface secondary lesions?
    • above - scales, lichenification, crust, atrophy
    • below - erosion, fissure, ulcer, scar, keloid, excoriation
  42. What are vascular abnormalities?
    Petechae, hematoma, purpura
  43. What is the scale for edema?
    • trace +1 - 2mm
    • Mild +2 - 4mm, 10-15 seconds response
    • Moderate +3 - 6mm, 1-2 minutes response
    • Severe +4 - 8mm, 2-5 minutes response
  44. What is onychomycosis?
    Fungal infection of nail, thickening, browning, crumbling, patching
  45. What is clubbing of the nails?
    caused by hypoxia, normal nail angle 160, early - 180, late - over 180. Do Schamroth technique to test
  46. What is normal capillary refill for finger and toenails?
    • fingernails - under 3 sec
    • toenails - under 5 seconds
    • checks for perepheral oxygenation
  47. What is acute pain?
    It is short lived, has sympathetic system involvement (increased pulse and blood pressure)
  48. What is chronic pain?
    Long standing pain with adaptation of sympathetic nervous system
  49. What are the three categories of chronic pain?
    • Chronic malignant
    • Chronic nonmalignant
    • Persistant or recurring
  50. What are harmful effects of unrelieved pain?
    • Endocrine - prolonged stress response
    • Cardiovascular - increased HR, O2 demand, BP, hypercoagulation
    • Respiratory - disfunction
    • GI - decreased motility
    • Musculoskeletal - muscle spasm or immobility
    • Cognitive - confusion
    • Immune - depressed immune response, enhanced tumor growth
    • Infection - decreased subcutaneous O2
    • Emotional
  51. Where do you assess strength and regularity of aortic pulsations?
    Suprasternal notch
  52. Where does the trachea bifurcate?
    at the angle of Louis
  53. What rib is at the tip of the scapula?
  54. What is the posterior equivilent of the Angle of Louis?
  55. How is the right main bronchus different to the left?
    wider, shorter, more vertical, more succeptable to aspiration
  56. Where are the apices of the lungs located?
    2-4 cm above 1st rib into base of neck
  57. Where is the base of the lung located?
    T10 posterior, 8th rib axillary, 4th rib anteriorly
  58. Which lung lobe has 3 compartments?
    Right anterior
  59. Where are the most common symptoms of respiratory disfunction?
    Dyspnea, cough, sputum production, chest pain
  60. What are objective signs of dyspnea?
    increased respiratory rate, nasal flairing, dusky mucosa, use of accessory muscles to breathe
  61. How does respiration change with aging?
    chest wall becomes more ridged, respiratory muscles weaken, shallower breathing, decrease in elastic recoil, alveoli less elastic, decreased cough reflex
  62. What is the most important assessment?
  63. What is the tripod position?
    using arms to support weight and lift chest to increase breathing capacity
  64. What is a barrel chest?
    Occurs with COPD, chest appears in continuous inspiration, kyphosis, costal angle greater than 90 degrees
  65. What is stridor??
    an inspiratory wheeze that is heard in trachea
  66. What are Cheyne-Stokes?
    cyclic pattern of apnea and varied breathing in final stages of life.
  67. What is Kussmaul's respiration?
    Hyperpnea and hyperventalation - happens with DKA
  68. What is crepitus?
    a cracking sensation felt when palpating
  69. What is tactile fremitus?
    vibrations of air in bronchial tubes heard when patient says "99"
  70. When would tactile fremadus be reduced?
  71. When would tactile frematus be increased?
    pneumonia, tumor
  72. What is normal resonance when percussing thorax?
    loud intensity, low pitch, long duration, hollow sounding
  73. What would be indicated by hyperresonance when percussing thorax?
    COPD, pneumothorax
  74. What would be indicated by dullness when percussing thorax?
    pneumonia, tumor
  75. what are normal tracheal breath sounds?
    loud, high pitched, harsh, hollow. Inspiration = expiration
  76. What are normal bronchiovesicular breath sounds?
    Intermediate intensity and pitch
  77. What are normal vesicular breath sounds?
    soft, low pitched, breezy, swishy. Inspiration longer than expiration
  78. What are 3 characteristics of crackles?
    occur on inspiration, discontinuous, air through fluid
  79. What are three characteristics of wheezes?
    occur on expiration, continuous, air through bronchoconstriction with inflammation
  80. What are fine crackles?
    high pitched, discontinuous popping sounds at the end of inspiration
  81. What are medium crackles?
    lower more moist sounds heard mid inspiration
  82. What are coarse crackles?
    louder, lower pitched bubbly sounds through inspiration
  83. What are sibilant wheezes?
    prolonged high pitched, musical sound heard primarily on expiration
  84. What are sonorous wheezes?
    low pitched snoring or moaning sound heard primarily in expiration but can be throughout